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Zeineb Alaya, Walid Osman
Annelies S. Post, I. Guiraud, M. Peeters, P. Lompo, S. Ombelet, I. Karama, S. Yougbaré, Z. Garba, E. Rouamba, H. Tinto, Jan Jacobs
BackgroundIn low- and middle-income countries, surveillance of antimicrobial resistance (AMR) is mostly hospital-based and, in view of poor access to clinical microbiology, biased to more resistant pathogens. We aimed to assess AMR among Escherichia coli isolates obtained from urine cultures of pregnant women as an indicator for community AMR and compared the AMR results with those from E. coli isolates obtained from febrile patients in previously published clinical surveillance studies conducted within the same population in Nanoro, rural Burkina Faso. We furthermore explored feasibility of adding urine culture to standard antenatal care in a rural sub-Saharan African setting.MethodsBetween October 2016–September 2018, midstream urine samples collected as part of routine antenatal care in Nanoro district were cultured by a dipslide method and screened for antibiotic residues. Significant growth was defined as a pure culture of Enterobacterales at counts of ≥ 104 colony forming units/ml.ResultsSignificant growth was observed in 202/5934 (3.4%) cultures; E. coli represented 155 (76.7%) of isolates. Among E. coli isolates, resistance rates to ampicillin, cotrimoxazole and ciprofloxacin were respectively 65.8%, 64.4% 16.2%, compared to 89.5%, 89.5% and 62.5% among E. coli from clinical isolates (n = 48 of which 45 from blood cultures). Proportions of extended spectrum beta-lactamase producers and multidrug resistance were 3.2% and 5.2% among E. coli isolates from urine in pregnant women versus 35.4%, and 60.4% respectively among clinical isolates.ConclusionsThe E. coli isolates obtained from healthy pregnant women had significantly lower AMR rates compared to clinical E. coli isolates, probably reflecting the lower antibiotic pressure in the pregnant women population. Adding urine culture to the routine urine analysis (dipstick) of antenatal care was feasible. The dipslide culture method was affordable and user-friendly and allowed on-site inoculation and easy transpor
Daniel Bernoulli, Dominique Chapelle
Note du transcripteur: Cette transcription se veut parfaitement fidèle à l'original du mémoire (accessible sur le site Gallica de la BNF), ma motivation étant avant tout de rendre celui-ci plus facile d'accès et de lecture, et rendre ainsi hommage à cette oeuvre pionnière, et relativement méconnue parmi toutes les contributions de Daniel Bernoulli. Je me suis donc contenté d'appliquer des modifications mineures liées à l'orthographe moderne, sans changer la ponctuation (qui, quoiqu'un peu datée, ne suscite pas de difficulté de lecture), la grammaire étant par ailleurs parfaitement conforme aux règles encore en usage. Il va de soi que tous les retours sont les bienvenus sur cette transcription, qui pourra faire l'objet de révisions futures en fonction de ceux-ci.
Hicham Janah, Hanane Elouazzani, Hicham Souhi, Hicham Naji-Amrani, Adil Zegmout, Ismail Abderrahmani Rhorfi, Ahmed Abid
Le tabagisme est une des principales causes de morbidité et de mortalité évitable. Le but de ce travail est d’évaluer les connaissances du fumeur vis-à-vis les risques du tabac et son motivation pour cesser de fumer. Nous avons réalisé une enquête transversale chez les malades tabagiques hospitalisés au service en répondant à un questionnaire précisant leur niveau socio-économique et culturel, l'histoire du tabagisme, les méfaits connus du tabac, la dépendance pharmacologique à la nicotine et leur motivation pour cesser de fumer. Il s'agit de 120 patients, l’âge moyen était de 45 ans±15. Les principaux motifs d'hospitalisation étaient: pathologie tumorale (54%), pathologie infectieuse (35%) BPCO (9%). 85% des patients étaient scolarisés jusqu'au cycle secondaire. Pour l'ensemble des patients, l’âge moyen de la première cigarette était précoce (avant de 20 ans) et la dépendance pharmacologique à la nicotine était légère (82% avaient un score de Fagerström < 8). Plus d'un tiers des patients (38%) avaient au moins fait une tentative d'arrêt. La connaissance des effets néfastes du tabac était variable: les pathologies cancéreuses (88%), les maladies cardiovasculaires (65%) et la BPCO (31%). La majorité des patients (78%) avaient cessé de fumer depuis l'hospitalisation. Notre enquête met en évidence l'intérêt de la médiatisation dans l'information de la population sur les risques du tabac. Les pneumologues, qui prennent en charge la grande majorité de ces patients, doivent donc s'impliquer activement dans ce domaine.
Obiageli Nnodu, Anazoeze Madu, Reuben Chianumba, Hezekiah Alkali Isa, Isaac Olanrewaju, Samuel Osagie, Nash Oyekanmi, Raphael Zozimus Sangeda, Annemie Stewart, Victoria Nembaware, Jack Morrice, Mario Jonas, Gaston Mazandu, Ambroise Wonkam, Olumide Owolabi
Background: The Sickle Pan-African Research Consortium (SPARCO) and Sickle Africa Data Coordinating Center (SADaCC) were set up with funding from the US National Institute of Health (NIH) for physicians, scientists, patients, support groups, and statisticians to collaborate to reduce the high disease burden and alleviate the impact of Sickle Cell Disease (SCD) in Africa. For 5 years, SPARCO and SADaCC have been collecting basic clinical and demographic data from Nigeria, Tanzania, and Ghana. The resulting database will support analyses to estimate significant clinical events and provide directions for targeting interventions and assessing their impacts. Method: The Nigerian study sited at Centre of Excellence for Sickle Cell Disease Research and Training (CESRTA), University of Abuja, adopted REDCap for online database management. The case report form (CRF) was adapted from 1,400 data elements adopted by SPARCO sites. It captures 215 data elements of interest across sub-sites, i.e., demographic, social, diagnostic, clinical, laboratory, imaging, and others. These were harmonized using the SADaCC data dictionary. REDCap was installed on University of Abuja cloud server at https://www.redcap.uniabuja.edu.ng. Data collected at the sites are sent to CESRTA for collation, cleaning and uploading to the database. Results: 7,767 people living with sickle cell disease were enrolled at 25 health institutions across the six zones in Nigeria with 5,295 having had at least one follow-up visit with their clinical data updated. They range from 44 to 1,180 from 3 centers from South East, 4 from South, 5 from South West, 8 from North Central, 4 in North West and 3 in the North East. North West has registered 1,383 patients, representing 17.8%; North East, 359 (4.6%); North Central, 2,947 (37.9%); South West, 1,609 (20.7%); South, 442 (5.7%) and South East, 1,027 patients (13.2%). Conclusion: The database is being used to support studies including analysis of clinical phenotypes of S
Nchangwi Syntia Munung, Victoria Nembaware, Jantina de Vries, Daima Bukini, Furahini Tluway, Marsha Treadwell, Raphael Zozimus Sangeda, Gaston Mazandu, Mario Jonas, Vivian Paintsil, Obiageli E. Nnodu, Emmanuel Balandya, Julie Makani, Ambroise Wonkam
Sickle cell disease (SCD) is one of the most prevalent genetic conditions in sub-Saharan Africa. It is a chronic, lifelong disease often characterized by severe pain. However, SCD has received little investment terms of health research, though there is currently a growing pool of SCD data from health and research facilities in different countries. To facilitate research on SCD in Africa, the SickleInAfrica consortium has established a SickleInAfrica registry. The registry will store a systematic collection of longitudinal data from persons with SCD across sub-Saharan Africa, and currently, participants are being enrolled in Ghana, Nigeria, and Tanzania. In establishing this registry, the SickleInAfrica consortium decided to actively identify and anticipate possible ethical issues that may arise in the development and management of the registry. This was motivated, in part, by the near absence of well documented ethical issues for registry research in Africa, more-so for registries enrolling participants across multiple countries and for a genetic condition. The consortium aims to establish standards for the equitable use of data stored in the registry. This paper presents a comprehensive report on the ethical considerations that came up in setting up a genetic disease registry across multiple African countries and how they were addressed by the SickleInAfrica consortium. Major issues included: active involvement of patients in the initiation and management of the registry; questions of assent and re-consent; the importance of ensuring that fears of exploitation are not replicated in African–African research collaborations; and the importance of public engagement in the management of registries. Drawing on this experience, SickleInAfrica plans to set up an ethics helpdesk for genetic disease registries and research in Africa.
Vivian Paintsil, Evans Xorse Amuzu, Isaac Nyanor, Emmanuel Asafo-Adjei, Abdul Razak Mohammed, Suraj Abubakar Yawnumah, Yaa Gyamfua Oppong-Mensah, Samuel Blay Nguah, Paul Obeng, Elliot Eli Dogbe, Mario Jonas, Victoria Nembaware, Gaston Mazandu, Kwaku Ohene-Frempong, Ambroise Wonkam, Julie Makani, Daniel Ansong, Alex Osei-Akoto
Sickle cell disease (SCD) is the most common clinically significant hemoglobinopathy, characterized by painful episodes, anemia, high risk of infection, and other acute and chronic complications. In Africa, where the disease is most prevalent, large longitudinal data on patients and their outcomes are lacking. This article describes the experiences of the Kumasi Center for SCD at the Komfo Anokye Teaching Hospital (KCSCD-KATH), a Sickle Pan-African Research Consortium (SPARCO) site and a SickleInAfrica Consortium member, in establishing a SCD registry for the evaluation of the outcomes of patients. It also provides a report of a preliminary analysis of the data. The process of developing the registry database involved comprehensive review of the center’s SCD patient medical records, incorporating data elements developed by the SickleInAfrica Consortium and obtaining ethical clearance from the local Institutional Review Board. From December 2017 to March 2020, 3,148 SCD patients were enrolled into the SCD registry. Enrollment was during the SCD outpatient clinic visits or through home visits. A significant proportion of the patients was from the newborn screening cohort (50.3%) and was males (52.9%). SCD-SS, SCD-SC, and Sβ +thalassemia were seen in 67.2, 32.5, and 0.3% patients, respectively. The majority of the patients were in a steady state at enrollment; however, some were enrolled after discharge for an acute illness admission. The top two clinical diagnoses for SCD-SS patients were sickle cell painful events and acute anemia secondary to hyperhemolysis with incidence rates of 141.86 per 10,000 person months of observation (PMO) and 32.74 per 10,000 PMO, respectively. In SCD-SC patients, the top two diagnoses were sickle cell painful events and avascular necrosis with incidence rates of 203.09 per 10,000 PMO and 21.19 per 10,000 PMO, respectively. The SPARCO Kumasi site has developed skills and infrastructure to design, manage, and analyze data in the SCD regist
Nana Efua E Afun, Grace E Aye, Linda L Yevoo, Sue Godt, Charity Binka, Vicky Okine, Irene A Agyepong
SummaryObjectivesTo explore and analyse factors that facilitate and inhibit the initiation and functioning of a national and transnational Community of Practice (CoP) for health policy and systems (HPS) and Reproductive, Maternal, New-born, Child and Adolescent Health (RMNCAH) in West Africa and to identify lessons for CoP interventions in similar multilingual low and middle-income contexts.DesignA case study, with the case defined as processes, enablers and barriers to the initiation and functioning of a national and transnational CoP for HSP and RMNCAH in West Africa and drawing on a review and analysis of secondary data from the program, workshop, country team and project reports, and training sessions.SettingThe Economic Community of West African States (ECOWAS).ParticipantsProfessionals from two Anglophone (Ghana and Sierra Leone) and four Francophone (Burkina Faso, Cote d'Ivoire, Niger e Senegal) ECOWAS countries.InterventionsTraining and mentoring of multi-disciplinary country teams supported by small research grants to undertake formative evaluation and advocacy of priority HPS and RMNCAH issues; support for CoP development within and across country teams.ResultsThe desire to learn from peers and mentors was a major enabler of the process. Human and financial resource availability, competing demands for time, communication in the context of a Francophone-Anglophone official language divide and the arrival of COVID-19 were all constraints.ConclusionsThis study highlights the processes, achievements, and challenges of establishing country-level and transnational CoPs in West Africa. CoPs require sustained human and financial resource investments, communication and medium-to-long-term implementation support for sustainability and impact.FundingNone declared
B Kone, M Maiga, B Baya, YDS Sarro, N Coulibaly, A Kone, B Diarra, M Sanogo, ACG Togo, D Goita, M Dembele, MA Polis, J Warfield, M Belson, S Dao, S Orsega, RL Murphy, S Diallo, S Siddiqui
IntroductionMeasurement of immuno-hematological parameters has been historically helpful in the diagnosis and treatment monitoring of many infectious diseases and cancers. However, these parameters have not yet been established in many developing countries where patient care strongly relies on such low-cost tests. This study describes the immuno-hematological parameter ranges for Malian healthy adults.MethodsA cross sectional study was conducted from August 2004 to May 2013. We included 213 healthy volunteers (173 male and 40 female), aged between 18–59 years. Median, 2.5 and 97.5 percentile ranges for each immuno-hematological parameter are presented.ResultsIn our study population, the hematological parameters’ ranges were mostly different to the universal established ranges. We found in our population a Median white blood cell (WBC) count of 5200 cells/μL [3237.5–11900], Red Blood Cell (RBC) count of 4.94 10^6 [3.56–6.17], hemoglobin (Hb) of 14.2 g/dL [12.2–17.38], platelet count (Plt) of 275 10^3/μL [145.4–614.4], lymphocytes 2050/μL [1200–3800], neutrophils 2200/μL [1040–6220]; monocytes 200/μL [100–660]; eosinophils 131/μL [0–1026]; CD4 902 cells/μL [444–1669] and CD8 485 cells/μL [0–1272]. We found significant gender differences in RBC, Hb level and MPV. However, RBC and Hb were higher in males median values compared to females (median values) (p<0.001), whereas the Mean platelet volume lower values (MPV) in males than females (P<0.047). The hemoglobin level for some West African countries (Mali, Burkina Faso, Togo, and Nigeria) ranged from 13.5 to 15.1 g/dL for males and 12 to 13 g/dL for females. However in East and Southern Africa, the values were anywhere from 14.1 to 16.1 for males and 11.2 to 14.4 for females.ConclusionOur data may help physicians to better define hematological abnormalities in patients. They may also be used to define new “normal hematological values” in Malian population or in the whole West African population.
Djamila L. Ghafuri, Shehu U. Abdullahi, Abdu H. Dambatta, Jamil Galadanci, Musa A. Tabari, Halima Bello-Manga, Nura Idris, Hauwa Inuwa, Aliyu Tijjani, Aisha A. Suleiman, Binta W. Jibir, Safiya Gambo, Awwal I. Gambo, Yusuf Khalifa, Lawal Haliru, Sani Abdulrasheed, Mohammed A. Zakari, Brittany C. Greene, Edwin Trevathan, Lori C. Jordan, Muktar H. Aliyu, Ana A. Baumann, Michael R. DeBaun
We used the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to evaluate a Stroke Prevention Team’s readiness to prevent strokes in children with sickle cell anemia living in northern Nigeria. The NIH sponsored Stroke Prevention Trial in Nigeria included a goal of a sustainable stroke prevention program. The program’s 1-year reach for transcranial Doppler screening was 14.7% (4710/32,000) of which 6.0% (281/4710) had abnormal velocities (≥200 cm/s). All participants with abnormal transcranial Doppler velocities were started on hydroxyurea (effectiveness). The leaders of all 5 hospitals agreed to adopt the program. After 1 year, program-implementation and maintenance rates were 100%, demonstrating the program’s feasibility and short-term sustainability.
William A.C. Gendron, Robyn Raban, Agastya Mondal, Héctor M. Sánchez C, David Zilberman, Patrick G.C. Ilboudo, Umberto D’Alessandro, John M. Marshall, Omar S. Akbari
Malaria control has primarily been achieved through vector control, but current methods are insufficient to achieve elimination. Precision guided sterile insect technique (pgSIT) is a mosquito suppression technique that generates sterile male mosquitoes for mass release. Our previous studies showed that this intervention is expected to be highly cost-effective in a malaria endemic region of West Africa, but these estimates used only 15-31% capacity for sex sorting, which is the limiting production step and a primary cost. We, therefore, determined the most cost efficient facility size by calculating the cost per million Anopheles gambiae suppressed as the facility was scaled up to suppress more mosquitoes. We developed an optimized facility size per 9.2 million mosquitoes suppressed, which can be a framework for scaling and increases the cost effectiveness of this intervention. The development of this intervention can potentially interrupt malaria transmission, strengthen local public health institutions, create manufacturing capacity, provide local jobs, and enhance regional health security capabilities that are more resilient to disruptions in supply chains and malaria investment.
Elisha Adeniji, Kwaku Poku Asante, Owusu Boahen, Guillaume Compaoré, Boubacar Coulibaly, Seyram Kaali, Youssouf Kabore, Mathieu Lamy, John Lusingu, Anangisye Malabeja, Petra Mens, Mattéa Orsini, Lucas Otieno, Walter Otieno, Seth Owusu-Agyei, Janet Oyieko, Jean-Yves Pirçon, Nicolas Praet, François Roman, Ali Sie, Valentine Sing’oei, Sodiomon B. Sirima, Khadime Sylla, Roger Tine, Alfred B. Tiono, Mathilda Tivura, Effua Usuf, Stéphanie Wéry
Abstract.RTS,S/AS01E malaria vaccine safety, effectiveness, and impact will be assessed in pre- and post-vaccine introduction studies, comparing the occurrence of malaria cases and adverse events in vaccinated versus unvaccinated children. Because those comparisons may be confounded by potential year-to-year fluctuations in malaria transmission intensity and malaria control intervention usage, the latter should be carefully monitored to adequately adjust the analyses. This observational cross-sectional study is assessing Plasmodium falciparum parasite prevalence (PfPR) and malaria control intervention usage over nine annual surveys performed at peak parasite transmission. Plasmodium falciparum parasite prevalence was measured by microscopy and nucleic acid amplification test (quantitative PCR) in parallel in all participants, and defined as the proportion of infected participants among participants tested. Results of surveys 1 (S1) and 2 (S2), conducted in five sub-Saharan African countries, including some participating in the Malaria Vaccine Implementation Programme (MVIP), are reported herein; 4,208 and 4,199 children were, respectively, included in the analyses. Plasmodium falciparum parasite prevalence estimated using microscopy varied between study sites in both surveys, with the lowest prevalence in Senegalese sites and the highest in Burkina Faso. In sites located in the MVIP areas (Kintampo and Kombewa), PfPR in children aged 6 months to 4 years ranged from 24.8% to 27.3%, depending on the study site and the survey. Overall, 89.5% and 86.4% of children used a bednet in S1 and S2, of whom 68.7% and 77.9% used impregnated bednets. No major difference was observed between the two surveys in terms of PfPR or use of malaria control interventions.
Jean Claude Romaric Pingdwindé Ouédraogo, Sylvain Ilboudo, Prosper Bado, Tegwindé Rebeca Compaoré, Alix Tougma, Mathieu Nitiéma, Abdou Azaque Zouré, Lazare Belemnaba, Sylvin Ouédraogo, Léon Gueswendé Blaise Savadogo
BackgroundIn 2023, Burkina Faso experienced the largest dengue epidemic ever in Africa. This study aimed to estimate the prevalence of symptomatic, subclinical, and asymptomatic dengue and determine the associated factors among adult contacts of dengue in the Central Region, Burkina Faso.MethodsThis cross-sectional study included contacts of dengue probable cases through cluster sampling in 2022–2023. These suspected cases that tested positive were identified from the five health facilities (Pissy CMA, Saaba CM, Kossodo CMA, Samandin CM, and Marcoussis CSPS) that reported the highest number of cases in 2021 per district. All participants underwent dengue and malaria rapid diagnostic tests (RDT). Samples positive for non-structural 1 protein antigen (AgNS1) and/or immunoglobulin M (IgM) were tested for serotype detection by reverse transcription polymerase chain reaction (RT-PCR). Binary logistic regression was done to identify the determinants of asymptomatic, subclinical, and symptomatic dengue among contacts of probable dengue cases.ResultsA total of 484 contacts were included, mostly in 2023 (75.2%). Most participants were females (58.6%), residing (24.3%) and passing their daytime (23.1%) in Saaba. The overall prevalence of dengue was estimated at 15.1% [95% confidence interval (CI): 12.0–18.6%], representing cases not seeking care in hospitals. Asymptomatic cases represented 2.9% (95% CI: 1.6–4.8%). Subclinical and symptomatic cases accounted for 6.0% (95% CI: 4.1–8.5%) and 6.2% (95% CI: 4.2–8.7%), respectively. Of the 58 samples tested by RT-PCR, 10 were confirmed for serotype 3 in 2023. Malaria cases were estimated at 5.6% (95% CI: 3.7–8.0%). After adjustment, participants claiming that a virus transmits dengue were likelier to have asymptomatic dengue [adjusted odds ratio (aOR) = 7.1, 95% CI: 2.4–21.0]. From the multivariable analysis, subclinical dengue was statistically associated with being included in the study in 2023 (aOR = 30.2, 95% CI: 2.0–455.5) and
Background: Dengue, transmitted by Aedes spp. mosquitoes, poses significant public health challenges in Burkina Faso. This study investigated outbreak thresholds, utilizing historical data since 2018 to explore the climatic impacts on dengue transmission and address knowledge gaps. Methodology: This retrospective ecological study utilized historical and contemporary data from Burkina Faso’s Public Health Ministry (2018–2024) to model dengue outbreak thresholds. A combination of epidemic channel analysis, joinpoint regression, climate–disease relationship analysis, and negative binomial regression was employed to provide comprehensive insights into the factors driving dengue outbreaks. Principal Findings: The incidence of probable dengue cases remained stable, mostly below 5 cases per 100,000 people, except for a sharp surge in week 40 of 2023, peaking at 38 cases per 100,000. This surge was brief, normalizing by week 47, but coincided with a marked increase in mortality, reaching 90 deaths in week 45. Joinpoint regression identified key thresholds, an alert at 2.1 cases per 100,000 by week 41 and an intervention threshold at 19.1 cases by week 44, providing a framework for timely public health responses. Climatic factors significantly influenced dengue transmission, with higher temperatures (RR = 2.764) linked to increased incidence, while higher precipitation (RR = 0.551) was associated with lower case numbers, likely due to disrupted mosquito breeding conditions. Additionally, intermediate precipitation levels showed a complex relationship with higher incidence rates. Conclusions: This study established evidence-based epidemiological thresholds for dengue outbreak detection in Burkina Faso (2018–2024), demonstrating temperature as a primary transmission driver while precipitation showed inverse relationships. Analysis of the 2023 outbreak identified a critical five-week intervention window (weeks 40–45), providing a framework for climate-sensitive early warning sy
Grace Heymsfield, Elizabeth Radin, Marie Biotteau, Suvi Kangas, Zachary Tausanovitch, Casie Tesfai, Léonard Kiema, Wenldasida Thomas Ouedraogo, Badou Seni Mamoudou, Mahamat Garba Issa, Lievin Bangali, Marie Christine Atende Wa Ngboloko, Balki Chaïbou, Maman Bachirou Maman, Eva Leidman, Oleg Bilukha
BackgroundDespite their utility for program planning, acute malnutrition treatment coverage estimates at the national and sub-national levels are rarely available. Prior work has identified methodological concerns with current approaches.MethodsWe estimated the point prevalence and treatment coverage of acute malnutrition in 11 districts (or similar subnational areas) across four high-burden countries in Africa using representative cluster-based population survey methods and compared these estimates to those derived from administrative data and other direct methods where available. We also aimed to assess information about risk factors for malnourished children by coverage status.ResultsThe point estimate of coverage suggests that <20% of eligible children with severe acute malnutrition (SAM) were enrolled in treatment in nine administrative areas. We found that in some contexts, coverage estimates derived using administrative data are useful, while in others, they are not – and that their accuracy can vary by month and year. By comparison, coverage estimates from other direct methods were overestimated and/or outdated, and practitioners tended to overestimate coverage. Coverage did not differ significantly by sex or age of the child but did vary by mid-upper arm circumference (MUAC) at assessment. Measured SAM coverage did not correlate either with measured SAM prevalence or with expected coverage estimated a priori by program staff.ConclusionOur findings suggest that in the assessed high-burden countries, many more children are eligible for treatment than are enrolled. We present this methodology as an alternative to existing primary methods and a complement to coverage estimates from routine program and population data.
Jailos Lubinda, Susan F. Rumisha, Paulina Dzianach, Michael McPhail, Adam Saddler, Annie Browne, Francesca Sanna, Yalemzewod Gelaw, Paul Castle, Juniper B. Kiss, Joseph Harris, Jennifer A. Rozier, Camilo Vargas, Punam Amratia, Tasmin L. Symons, Ewan Cameron, Peter W. Gething, Daniel J. Weiss
Late diagnosis and treatment of malaria increase the odds of severe disease by nearly 2.8 times, enhance transmission rates, compromise drug effectiveness, and trigger malaria outbreaks. No continent-wide estimates for malaria treatment delay exist. We estimate delay rates among African children treated for malaria between 2006 and 2022, using 177 nationally representative surveys. We found that 60% [95% UI 45.7–72.8] of treated children experienced >24 h of delay, while 29% [95% UI 18.9–41.2] faced delays exceeding 48 h, affecting 33 million and 16 million children, respectively. Spatiotemporal variability exists across Africa. Somalia has the highest (76% [95% UI 39.7–97.9]) and Tanzania has the lowest (35.3% [95% UI 11.5–53.8]) delay rates. Overall, initial improvements in treatment delay stagnated post-2015, but East Africa showed the most progress, while Central and West Africa experienced increases. Socioeconomic factors and residence influenced delays, with poorer and rural populations facing higher rates. These findings are vital for policymakers to enhance malaria case management, access to effective treatment, and reduce malaria mortality among children. Delayed treatment for malaria increases the risk of severe disease. Here, the authors estimate the rates of treatment delay for children under five in malaria-endemic regions of Africa.
BackgroundIndividuals diagnosed with neurocysticercosis often present with epilepsy and sometimes with progressively worsening severe chronic headaches (WSCH). While cross-sectional associations between seropositivity to cysticercal antigens and epilepsy have been reported, few large scale studies have been conducted in West Africa and none have measured the association between seropositivity to cysticercal antigens and headaches. This study aimed at filling these knowledge gaps by estimating the strength of the cross-sectional association between seropositivity to cysticercal antigens and the prevalence of epilepsy and WSCH in 60 villages of Burkina Faso, West Africa.Methodology/Principal findingsBaseline data from a cluster randomized controlled trial collected from January 2011 to February 2012 in 60 villages across three provinces in Burkina Faso were used. Between 78 and 80 individuals were screened for epilepsy and WSCH in each village, and those screened positive were confirmed by a physician. Seventy-five percent of all participants were asked to provide a blood sample to test for Taenia solium cysticercus circulating antigens. Hierarchical multivariable logistic models were used to measure the association between seropositivity to cysticercal antigens and epilepsy (lifetime and active) as well as WSCH. Among 3696 individuals who provided a blood sample, 145 were found to have epilepsy only, 140 WSCH only and 19 both. There were positive associations between seropositivity to cysticercal antigens and active epilepsy (prevalence odds ratio (POR): 2.40 (95%CI: 1.15–5.00)) and WSCH (POR: 2.59 (1.34–4.99)).Conclusions/SignificanceOur study is the first to demonstrate a cross-sectional association between seropositivity to cysticercal antigens and WSCH in a large community-based study conducted in West Africa. The measured cross-sectional association had a strength similar to the ones previously observed between seropositivity to cysticercal antigens and lifetime
John Muthii Muriuki, Alexander J. Mentzer, Emily L. Webb, Alireza Morovat, Wandia Kimita, Francis M. Ndungu, Alex W. Macharia, Rosie J. Crane, James A. Berkley, Swaib A. Lule, Clare Cutland, Sodiomon B. Sirima, Amidou Diarra, Alfred B. Tiono, Philip Bejon, Shabir A. Madhi, Adrian V. S. Hill, Andrew M. Prentice, Parminder S. Suchdev, Alison M. Elliott, Thomas N. Williams, Sarah H. Atkinson
BackgroundIron deficiency (ID) is a major public health burden in African children and accurate prevalence estimates are important for effective nutritional interventions. However, ID may be incorrectly estimated in Africa because most measures of iron status are altered by inflammation and infections such as malaria. Through the current study, we have assessed different approaches to the prediction of iron status and estimated the burden of ID in African children.MethodsWe assayed iron and inflammatory biomarkers in 4853 children aged 0–8 years from Kenya, Uganda, Burkina Faso, South Africa, and The Gambia. We described iron status and its relationship with age, sex, inflammation, and malaria parasitemia. We defined ID using the WHO guideline (ferritin < 12 μg/L or < 30 μg/L in the presence of inflammation in children < 5 years old or < 15 μg/L in children ≥ 5 years old). We compared this with a recently proposed gold standard, which uses regression-correction for ferritin levels based on the relationship between ferritin levels, inflammatory markers, and malaria. We further investigated the utility of other iron biomarkers in predicting ID using the inflammation and malaria regression-corrected estimate as a gold standard.ResultsThe prevalence of ID was highest at 1 year of age and in male infants. Inflammation and malaria parasitemia were associated with all iron biomarkers, although transferrin saturation was least affected. Overall prevalence of WHO-defined ID was 34% compared to 52% using the inflammation and malaria regression-corrected estimate. This unidentified burden of ID increased with age and was highest in countries with high prevalence of inflammation and malaria, where up to a quarter of iron-deficient children were misclassified as iron replete. Transferrin saturation < 11% most closely predicted the prevalence of ID according to the regression-correction gold standard.ConclusionsThe prevalence of ID is underestimated in African children when defin
Jennifer L Milucky, Toussaint Compaore, Franck Obulbiga, Gretchen Cowman, Cynthia G Whitney, Brice Bicaba
BackgroundThe primary cause of death in Burkina Faso is lower respiratory tract infections, accounting for 1 in 7 deaths. The Ministry of Health is building surveillance for severe acute respiratory infections (SARI) in four districts. This study sought to determine the catchment area of the Boussé district hospital and to describe disease burden of individuals hospitalized for SARI.MethodsData were collected from hospital log books to identify individuals with a SARI diagnosis during 2015 and 2016. Residence of SARI patients was recorded to determine the catchment area of the hospital. Population data were used to estimate SARI incidence rates.ResultsInvestigators reviewed logs for 3034 hospital admissions; 885 SARI cases were identified. Five communes were identified as the hospital catchment area, with 770 SARI patients residing in these communes. The SARI incidence rate (IR) for all ages was 136 (95% confidence interval (CI) = 115, 161) and 266 (95% CI = 236, 300) cases per 100 000 population for 2015 and 2016, respectively. Children <1 (RI = 1111 cases per 100 000, 95% CI = 1047, 1178, and RI = 2425 cases per 100 000, 95% CI = 2330, 2524) and adults ≥65 years old (RI = 377 cases per 100 000, 95% CI = 341, 417, and RI = 816 cases per 100 000, 95% CI = 762, 874) had the highest burden of disease for 2015 and 2016, respectively.ConclusionOur analysis found high rates of SARI, especially among children <1 year of age, and marked variation in incidence between the years studied. These baseline data and the method developed will be useful for the new SARI surveillance system.
Katherine P. Adams, Michael Jarvis, Stephen A. Vosti, Mari S. Manger, Ann Tarini, Jérome W. Somé, Hervé Somda, Christine M. McDonald
AbstractZinc is an essential micronutrient that promotes normal growth, development and immune function. In the context of persistent dietary zinc inadequacies, large‐scale food fortification can help fill the gap between intake and requirements. Burkina Faso mandates wheat flour fortification with iron and folic acid. We used activity‐based cost modelling to estimate the cost of adding zinc to the country's wheat flour fortification standard assuming (1) no change in compliance with the national standard, and (2) a substantial improvement in compliance. We used household food consumption data to model effective coverage, that is, the number of women of reproductive age (WRA) predicted to achieve adequate zinc density (zinc intake/1000 kcal) with the addition of fortification to diets. Without interventions, the prevalence of inadequate dietary zinc density was ~35.5%. With no change in compliance, the annual average incremental cost of adding zinc to fortified wheat flour was $10,347, which would effectively cover <1% of WRA at an incremental cost of ~$0.54/WRA effectively covered. Improving compliance added ~$300,000/year to the cost of the fortification programme without zinc; including zinc added another ~$78,000/year but only reduced inadequate intake among WRA by 3.6% at an incremental cost of ~$0.45/WRA effectively covered. Although the incremental cost of adding zinc to wheat flour is low ($0.01/wheat flour consumer/year), given low levels of wheat flour consumption, zinc fortification of wheat flour alone contributes marginally to, but will not fully close, the dietary zinc gap. Future research should explore potential contributions of zinc to a broader set of delivery vehicles. Key messages Large‐scale food fortification can be an effective strategy for reducing zinc deficiency.Dietary zinc inadequacy is a public health problem in Burkina Faso. We modelled the potential effectiveness and cost‐effectiveness of fortifying wheat flour with zinc to help addres
Patrick G. C. Ilboudo, Giulia Greco, Johanne Sundby, Gaute Torsvik
BackgroundTreatment costs of induced abortion complications can consume a substantial amount of hospital resources. This use of hospitals scarce resources to treat induced abortion complications may affect hospitals’ capacities to deliver other health care services. In spite of the importance of studying the burden of the treatment of induced abortion complications, few studies have been conducted to document the costs of treating abortion complications in Burkina Faso. Our objective was to estimate the costs of six abortion complications including incomplete abortion, hemorrhage, shock, infection/sepsis, cervix or vagina laceration, and uterus perforation treated in two public referral hospital facilities in Ouagadougou and the cost saving of providing safe abortion care services.MethodsThe distribution of abortion-related complications was assessed through a review of postabortion care-registers combined with interviews with key informants in maternity wards and in hospital facilities. Two structured questionnaires were used for data collection following the perspective of the hospital. The first questionnaire collected information on the units and the unit costs of drugs and medical supplies used in the treatment of each complication. The second questionnaire gathered information on salaries and overhead expenses. All data were entered in a spreadsheet designed for studying abortion, and analyses were performed on Excel 2007.ResultsAcross six types of abortion complications, the mean cost per patient was USD45.86. The total cost to these two public referral hospital facilities for treating the complications of abortion was USD22,472.53 in 2010 equivalent to USD24,466.21 in 2015. Provision of safe abortion care services to women who suffered from complications of unsafe induced abortion and who received care in these public hospitals would only have cost USD2,694, giving potential savings of more than USD19,778.53 in that year.ConclusionsThe treatment of the compl
Jacqueline K. Lim, Mabel Carabali, Tansy Edwards, Ahmed Barro, Jung-Seok Lee, Desire Dahourou, Kang Sung Lee, Teguewende Nikiema, Mee Young Shin, Emmanuel Bonnet, Therese Kagone, Losseni Kaba, Suk Namkung, Paul-André Somé, Jae Seung Yang, Valéry Ridde, In-Kyu Yoon, Neal Alexander, Yaro Seydou
Because of limited data on dengue virus in Burkina Faso, we conducted 4 consecutive age-stratified longitudinal serologic surveys, ≈6 months apart, among persons 1–55 years of age, during June 2015–March 2017, which included a 2016 outbreak. The seroconversion rate before the serosurvey enrollment was estimated by binomial regression, taking age as the duration of exposure, and assuming constant force of infection (FOI) over age and calendar time. We calculated FOI between consecutive surveys and rate ratios for potentially associated characteristics based on seroconversion using the duration of intervals. Among 2,897 persons at enrollment, 66.3% were IgG-positive, and estimated annual FOI was 5.95%. Of 1,269 enrollees participating in all 4 serosurveys, 438 were IgG-negative at enrollment. The annualized FOI ranged from 10% to 20% (during the 2016 outbreak). Overall, we observed high FOI for dengue. These results could support decision-making about control and preventive measures for dengue.
Malaria constitutes a major public health burden in sub-Saharan Africa. It remains a key health concern and the leading cause of death in children under five in Benin. Since October 2021, the World Health Organization has recommended the use of malaria vaccines for the prevention of Plasmodium falciparum malaria in children living in malaria endemic areas, prioritizing areas of moderate and high transmission in sub-Saharan Africa. However, with the exception of Ghana, there is a scarcity of studies modelling the potential impact of the RTS,S/AS01 vaccine in the context of West Africa. A compartmental mathematical model was developed to estimate clinical and severe malaria cases averted in children under five with the primary series of the RTS,S/AS01 malaria vaccine in Benin. Over a period of 10 years, scenarios involving vaccine introduction at different coverage levels alongside the use of long-lasting insecticidal nets were modelled to assess the impact of the RTS,S/AS01 vaccine on malaria transmission. The combination of childhood malaria vaccination at a coverage similar to that of the third dose of diphtheria, tetanus, and pertussis (DTP3) vaccine, along with the current use of nets, is projected to result in a 40% reduction in malaria clinical cases and deaths among children under five years old, compared to using nets alone, from 2025 to 2034. However, if the introduction of a malaria vaccine has the unintended consequence of decreased net use, cumulative benefits may be offset. A 1.5-fold decrease in the use of nets is projected to result in an increase in malaria burden. This modelling exercise concludes that childhood vaccination is expected to avert clinical and severe cases of malaria and is an additional tool to advance malaria control efforts in Benin but potential unintended consequences of a reduction in net usage may reduce these gains. Author summaryThis study addresses a key research gap by modelling the impact of childhood malaria vaccination on
Richmond Owusu, Colin Gilmartin, Halimatou Diawara, Fadima Bocoum, Oumy Ndiaye, Anika Ruisch, Genevieve Cecilia Aryeetey, Darlene Jainie, Monica Kokovena, Damian Walker, Justice Nonvignon
BackgroundSeasonal malaria chemoprevention (SMC) is a widely implemented malaria prevention strategy for children under five in the Sahel and sub-Sahel regions of Africa. This study aimed to estimate the full opportunity costs associated with SMC implementation in Mali, Burkina Faso and Senegal, addressing a gap in existing research that often focused solely on health system costs.Using a repeated descriptive cross-sectional design, data were collected from April to November 2022 during two SMC cycles. The study involved 376 caregivers in Mali, 398 in Senegal and 373 in Burkina Faso, alongside 127 community health volunteers in Mali, 41 in Senegal and 97 in Burkina Faso. Health worker supervisors recruited were 96 in Mali, 96 in Senegal and 42 in Burkina Faso. Data collection occurred across 15 health facilities in Burkina Faso and Senegal and 16 health facilities in Mali across four districts within each country.Both financial and economic costs were analysed using an ingredients approach, encompassing direct and indirect costs. Financial costs per SMC dose were estimated at US$0.99 in Mali, US$1.42 in Burkina Faso and US$1.51 in Senegal. Economic costs per dose were US$3.02 in Senegal, US$3.14 in Burkina Faso and US$2.96 in Mali. Total annual costs per child receiving four doses ranged from US$3.97 to US$6.05 for financial costs and US$11.85 to US$12.57 for economic costs. Notably, indirect costs, mainly related to productivity losses among caregivers, volunteers and healthcare workers, constituted 50%–66% of total economic costs.The findings highlight the economic cost of SMC implementation, driven largely by productivity losses of caregivers and volunteers which have often been overlooked in policy decisions. This study highlights the need for comprehensive cost assessments in malaria control programmes to inform effective decision-making.